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Prior Authorization Specialist

EBlu Solutions

EBlu Solutions

Operations
Louisville, KY, USA
Posted on Tuesday, June 25, 2024
Job Type
Full-time
Description

Are you Looking for an opportunity to help Providers ensure Prior Authorization is completed accurately and timely?

This is the role for you!! eBlu's Prior Authorization Specialist role is a key role that provides a service to practices throughout the United States to initiate and monitor Prior Authorization to completion. We are looking for individuals who are patient, able to pivot when needed, have attention to detail, and possess positive attributes.

This role has position expectations and responsibilities that are set up in tier success so you are aware of your progress at any time of your journey to help move to that next level. eBlu is a growing company with the potential to continue growth for those seeking those steps.

Highlights to consider before applying:

Starting pay is $20 an hour

In-Office position: Monday through Friday 8:00 am to 4:30 pm

The location is Downtown Louisville

POSITION SUMMARY:

The Prior Authorization Specialist is responsible for tracking the client’s prior authorization status through completion. The Prior Authorization Specialist will accurately process the requests according to regulatory and client-specific guidelines.

RESPONSIBILITIES:

  • Submit prior authorization forms to the payer
  • Contact payers to verify authorization status
  • Track and manage the authorization process
  • Maintain and update payer prior authorization forms
  • Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner.
  • Process authorizations based on department guidelines and in accordance with standards and performance indicators
  • Maintain all patient confidentiality
  • Manage prior authorization activity queue
  • Provides timely communication throughout the prior authorization process
  • Conducts appropriate follow-up, on a daily basis, on all pending authorizations until a final determination has been made
  • Conduct complete medical and pharmacy Benefit Investigations as needed
Requirements

PHYSICAL AND TECHNICAL ENVIRONMENT:

  • Ability to work at a desk in the office for long periods of time.
  • The noise level in the work environment is moderate.
  • Specific vision abilities required by this job include close vision and color vision.
  • Ability to maintain focus under high levels of pressure/multiple priorities.

REQUIRED EXPERIENCE:

  • Three to five years’ experience in a health plan, facility, healthcare provider office, or pharmaceutical industry
  • Experience working with insurance companies and extensive knowledge of different types of coverage and policies.
  • Experience with pre-certification or pre-authorization
  • Excellent multitasking skills.
  • Have exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
  • Ability to focus and work quickly within a 24-hour turnaround for patient insurance information.
  • Authorization to work in the US without sponsorship.
  • Ability to express ideas clearly in both written and oral communications

PREFERRED EXPERIENCE, SKILLS, AND ABILITIES:

  • Three to five years’ experience in a call center preferred
  • Knowledge of medical terminology preferred
  • Working knowledge of drug reimbursement issues
  • Understanding of health plan medical policies and prior authorization criteria
  • Knowledge of HCPCS, CPT and ICD-10 coding
  • Strong computer skills; preferably Microsoft Word or Excel software applications
  • Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
  • Ability to manage multiple priorities concurrently

REQUIRED EDUCATION:

  • Bachelor’s degree or equivalent work experience

EEO CODE – eBluSolutions is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law. eBlu Solutions is an Equal Employment Opportunity and Affirmative Action Employer.

EO/Minorities/Females/Disabled/Veterans

Salary Description
$20